HighPoint Vendor Evaluations

Co-authors: Norita Wilson and Becky Jones

In our previous blog A Closer Look at Population Health/Care Management Solution Vendors , we looked at Gartner’s March 2018 “Market Guide for Healthcare Payer Care Management Workflow Applications,” and its recommendations for health plans who are evaluating care management workflow application vendors.

We will now explore how health plans should evaluate care management workflow application vendors Key Performance Indicators, and the vendor selection process.

More than just an RFP

When a health plan is evaluating care management workflow application vendors, they should look at more than just the Request for Proposal or Proof of Concept.

The evaluation should also include whether the application is flexible and adaptable, whether it’s user-friendly and intuitive, requiring less training. Health plans should examine the interface-bridge between systems that use custom coding and import routines and/or utilities to transfer information.

The system should also have the ability to view or link to other systems, because of the need to centralize functions into a single system. It should also be interoperable (e.g., HL7 and EHR) and be able to work with other systems.

The application should also have the following capabilities:

  • Automated workflows based on complex business rules
  • Accessibility from any location using any device
  • Vendor awareness of client-expertise with complex Model of Care, Long Term Services and Support (LTSS) as part of Medicaid, and Dual Special Needs Plan (DSNP), a Medicare Advantage plan. Vendors must be nimble with every changing regulation. The vendor should have experience with the complexities of each state’s Model of Care. State LTSS have specific requirements for assessments, care plans, reporting, etc. The same applies to DSNP, however CMS has additional layers for states to meet criteria and regulations.
  • Expertise (e.g., for usability issues, workflow processing, hand-off processes and the reduction of manual processes).
  • Out-of-the-box rather than customizations, and the vendor’s ability to provide further details on their out-of-the-box strategy.

Co-authors: Norita Wilson is an associate director and Becky Jones is a senior manager with HighPoint Solutions Population Health Management practice.